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Pensions and Benefits
SCHOOL EMPLOYEES' HEALTH BENEFITS PROGRAM (SEHBP)
RETIREE PRESCRIPTION DRUG COPAYMENTS

LOCAL EDUCATION RETIREE COPAYMENT AMOUNTS

Click for State and Local Government Retiree Copayments

Plan Year 2014 prescription drug copayments for Retired Group SEHBP members.

Retiree prescription drug copayments are based on the medical plan in which the retiree is enrolled.

Aetna Freedom10 or 15 or NJ DIRECT10 or 15 | Aetna HMO or Horizon HMO | 1525 Plans | 2030 Plans | High Deductible Health Plans

Aetna Freedom10, NJ DIRECT10, Aetna Freedom15, NJ DIRECT15

RETAIL PHARMACY COPAYMENT AMOUNTS
Up to a 90-day Supply
Supply Generic Preferred
Brand Name Drugs
All Other
Brand Name Drugs
01-30 days $10 $21 $42
31-60 days $20 $42 $84
61-90 days $30 $63 $126


MAIL ORDER COPAYMENT AMOUNTS
Up to a 90-day Supply
Supply Generic Preferred
Brand Name Drugs
All Other
Brand Name Drugs
01-90 days $5 $31 $52

Under Aetna Freedom10, NJ DIRECT10, Aetna Freedom15, or NJ DIRECT15 there is an annual maximum out-of-pocket amount for prescription drug copayments of $1,411 per person. Once a person has paid $1,411 in copayments in a calendar year, that person is no longer required to pay any prescription drug copayments for the remainder of that calendar year. Prescription drug copayments are not eligible for further reimbursement by Aetna Freedom10, NJ DIRECT10, Aetna Freedom15, or NJ DIRECT15 and do not apply to medical plan deductibles or coinsurance.

Aetna HMO, Horizon HMO

RETAIL PHARMACY COPAYMENT AMOUNTS
Up to a 90-day Supply
Supply Generic Preferred
Brand Name Drugs
All Other
Brand Name Drugs
01-30 days $6 $13 $26
31-60 days $12 $26 $52
61-90 days $18 $39 $78


MAIL ORDER COPAYMENT AMOUNTS
Up to a 90-day Supply
Supply Generic Preferred
Brand Name Drugs
All Other
Brand Name Drugs
01-90 days $5 $19 $31

Under Aetna HMO or Horizon HMO there is an annual maximum out-of-pocket amount for prescription drug copayments of $1,411 per person. Once a person has paid $1,411 in copayments in a calendar year, that person is no longer required to pay any prescription drug copayments for the remainder of that calendar year. Prescription drug copayments are not eligible for further reimbursement by Aetna HMO or Cigna HealthCare HMO and do not apply to medical plan deductibles or coinsurance.

Aetna Freedom 1525, NJ DIRECT1525, Aetna HMO1525, Horizon HMO1525

RETAIL PHARMACY COPAYMENT AMOUNTS
Up to a 90-day Supply
Supply Generic Preferred
Brand Name Drugs
All Other
Brand Name Drugs
01-30 days $7 $17 $36
31-60 days $14 $34 $72
61-90 days $21 $51 $108


MAIL ORDER COPAYMENT AMOUNTS
Up to a 90-day Supply
Supply Generic Preferred
Brand Name Drugs
All Other
Brand Name Drugs
01-90 days $5 $41 $91

Under Aetna Freedom1525, NJ DIRECT1525, Aetna HMO1525, or Horizon HMO1525 there is an annual maximum out-of-pocket amount for prescription drug copayments of $1,411 per person. Once a person has paid $1,411 in copayments in a calendar year, that person is no longer required to pay any prescription drug copayments for the remainder of that calendar year. Prescription drug copayments are not eligible for further reimbursement by Aetna Freedom1525, NJ DIRECT1525, Aetna HMO1525, or Horizon HMO1525 and do not apply to medical plan deductibles or coinsurance.

Aetna Freedom2030, NJ DIRECT2030, Aetna HMO2030, Horizon HMO2030

RETAIL PHARMACY COPAYMENT AMOUNTS
Up to a 90-day Supply
Supply Generic Preferred
Brand Name Drugs
All Other
Brand Name Drugs
01-30 days $3 $19 $48
31-60 days $6 $38 $96
61-90 days $9 $57 $144


MAIL ORDER COPAYMENT AMOUNTS
Up to a 90-day Supply
Supply Generic Preferred
Brand Name Drugs
All Other
Brand Name Drugs
01-90 days $5 $37 $95

Medicare eligible retirees cannot enroll in Aetna Freedom2030 or Aetna HMO 2030.

Under Aetna Freedom2030, NJ DIRECT2030, Aetna HMO2030, or Horizon HMO2030 there is an annual maximum out-of-pocket amount for prescription drug copayments of $1,411 per person. Once a person has paid $1,411 in copayments in a calendar year, that person is no longer required to pay any prescription drug copayments for the remainder of that calendar year. Prescription drug copayments are not eligible for further reimbursement by Aetna Freedom2030, NJ DIRECT2030, Aetna HMO2030, or Horizon HMO2030 and do not apply to medical plan deductibles or coinsurance.

Aetna Value HD4000, NJ DIRECT HD4000

Under the High Deductible Health Plans (HDHP) prescription drug benefits are subject to the HDHP deductible and coinsurance. See your plan handbook or contact your HDHP directly for details.

Medicare eligible retirees cannot enroll in any of the High Deductible Health Plans (HDHP).


If you have any questions regarding this information, contact the Office of Client Services at
(609) 292-7524 or send an e-mail using the "contact us" link below.

 
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